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Patients Cycle Through The System Due To Shortage Of Mental Health Facilities

 April 16, 2019 at 10:28 AM PDT

Speaker 1: 00:00 More people dealing with a mental health crisis are seeking help at county emergency rooms and staying longer due to a lack of next step facilities in the county. The shortage forces some patients to go without the care they need. Thus repeating the cycle at UC San Diego Health La Hoya and Hillcrest Ers, they saw a 22% increase last year as compared to 2014 that's according to reporting by Jared Whitlock of the San Diego Business Journal is three part series on mental health care and the county wrapped up yesterday. He joins me now to discuss his reporting. Welcome Jared. Thanks for having me. So how has UC San Diego specifically responded to the increase they're seeing? Speaker 2: 00:39 Like other hospitals, Uc San Diego Health has added behavioral health workers to make the rounds in ers for a quicker triage. Uc San Diego Health has also sought to cut down on Er readmissions. That's through expanding outpatient services as well as greater numbers of case management workers who connect patients and an er with the appropriate services. And Palomar hospital has come up with a unique way to handle the increased. To tell me about that. Yeah. They have a crisis stabilization unit, which is specially designed for behavioral health. I'm told the environment is more relaxed than a typical er and the unit allows patients to stay for up to 24 hours under the watch of specially trained behavioral health workers. So after the Er, a patient would typically go on to an inpatient facility. Are there enough of those in the county? San Diego has roughly 700 inpatient beds or stated another way. That's 21 inpatient beds per 100,000 people. The goal is 50 beds per 100,000 people. So we have a shortage and the shortage has grown more acute over time. We had a peak of 1000 beds in San Diego in 1999 and uh, so from 1000 to 700 meanwhile, the population has grown in that span. But the area where Speaker 1: 02:08 we're seeing the largest shortage is in longer term facilities. Is it clear if, if this is caused by the increased need for services or does it predate that even Speaker 2: 02:17 there's been an increase in behavioral health cases while the number of facilities catering to a longterm care fell? So there's this, a supply demand imbalance has grown over time. Uh, it didn't happen overnight, but over the last decade it's grown more acute. And when would someone need to go to one of these longer term facilities and what services do they provide? Yeah, so some patients after inpatient care they will go home. Uh, but some patients will need continuing care. That includes a boarding care facility. These are licensed homes for someone who can function outside of a locked in patient unit, but they still need medication assistance and other support. You also have IMD beds which are for more severe cases. And that's for longer term care. Those are just two of the continuing care bed categories there. There are a few others as well. But those, those are two major ones. Speaker 2: 03:18 So bottom line, not having enough of the longer term mental health treatment facilities, uh, ends up causing those patients to stay. At the hospitals for longer periods of time. How long is the typical stay and how does this impact the hospitals? So in San Diego last year, nearly 1400 medical behavioral health patients experienced at least one day waiting for continuing care. That's more than five times. The number of medical patients who waited a decade prior and their weight for a continuing care bed averaged almost two weeks. And so how do these longer stays impact the patient's physicians say that it can lead to poor patient outcomes because these patients do get discouraged when they're just in limbo waiting. Is the shortage in longterm beds, uh, causing this cycle to be repeated? Yes. I did speak with a hospital officials and they said that sometimes a behavioral health patient who needs a continuing care bed, they get tired of waiting and they'll settle for a facility that's incompatible with their needs. Speaker 2: 04:25 And that means that their chances of being successful aren't so great and they could cycle through the system again. And what are the reasons for this shortage and longer term mental health facilities? The reason is because those who operate these facilities over time have found it's a tougher area to pencil out. The reimbursement hasn't kept up with the growing expenses in this area and hospitals are posing a solution and that's to have the county cover the additional cost. How does the county feel about that idea? Yeah, so I spoke with a supervisor, Dianne Jacob about this and she said that all options are on the table here. But I will say that the county sent over data showing increased funding for continuing behavioral health beds over time. And uh, I will also say that the hospitals would like to see the scout county spend more from the mental health services act, a ballot measure that it was approved in 2004. We'll see if that happens and how much money is available from the mental health services act. So there's 99 million in unspent revenue. It's hospitals have said that they would like to see more of that revenue spent on this continuing care phase. But, uh, it does appear that this, uh, these funds will run out in a few years. I've been speaking with Jared Whitlock of the San Diego Business Journal. Jared, thanks so much for joining us. Thanks.

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There is a shortage of both inpatient and longer-term care facilities in San Diego County.